As you may know, the Standards of Practice set out the minimum standards in paramedic services. Each regulated member is required to understand and comply with these Standards, but how does this translate in the day-to-day work of EMRs, PCPs and ACPS?
In an effort to help regulated members understand and apply the Standards to real life situations, we will be sharing scenarios that give context to the Standards and ideas on how to implement this into practice.
The following scenario will attempt to address consent. This is part two of a series explaining the difference between informed consent and implied consent. Part one can be found here.
2.2 Consent
Consent in paramedicine can be achieved by either informed or implied consent.
2.2.2 Implied Consent
A regulated member who attends a patient who is unconscious, unresponsive or otherwise unable to provide informed consent may reasonably determine implied consent exists if:
- The patient was the one who called for emergency medical services but was unconscious, unresponsive or unable to provide informed consent upon the regulated member’s arrival.
- The patient was involved in a life-threatening accident or has had a life-threatening health event (such as a cardiac event) that rendered them unable to provide informed consent.
Scenario:
Don is a seasoned PCP working near the remote community of Rainbow Lake. Don is dispatched to an industrial site for a 52-year-old male complaining of “chest tightness”. Upon arrival at the industrial site, Don and his partner Lindsey are met by the Occupational Health and Safety (OHS) Officer on site who guides them to the medical trailer where the patient is located. The OHS Officer lets Don and Lindsey know that this gentleman, named Henry, has previously stated he did not want to be taken to hospital or go through the process of flying out of camp, but he was open to getting an assessment done. Don and Lindsey thank the Officer for this information and proceed to enter the medical trailer to perform their assessment on the 52-year-old male.
As Don and Lindsey enter the trailer, they observe a 52-year-old male patient actively collapsing to floor while grasping his chest. They attempt to introduce themselves as paramedics and let Henry know they are there to help. The patient is not able to track Don and Lindsey, nor is he able to converse with them as he is unconscious with agonal respirations. Upon further assessment, Henry remains unconscious, unresponsive and unable to provide informed consent in regard to his own medical assessments and treatments. At this point, Don and Lindsey determine that implied consent exists, despite the patient not being the one who called for emergency medical services. Additionally, because Henry is involved in a life-threatening health event (such as a cardiac event) that renders him unable to provide informed consent, it is assumed that implied consent is given to Don and Lindsey to initiative CPR and life-saving measures in this circumstance.
In this example, Don and Lindsey both demonstrate their knowledge and adherence to the Standard 2.2.2 Implied Consent, where a regulated member who attends a patient who is unconscious, unresponsive or otherwise unable to provide informed consent may reasonably determine implied consent exists if the patient was the one who called for emergency medical services but was unconscious, unresponsive or unable to provide informed consent upon the regulated member’s arrival. Additionally, in this scenario, the patient was also involved in a life-threatening health event (such as a cardiac event) that rendered him unable to provide informed consent.